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c82e3d92-e10d-4bcb-8860-bbd7f0679be1 | Intimations. Statutory. Factories 116 8 — — Workshops 87 20 — _ Workplaces 167 6 — — Total 370 34 — _ 43 2. DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found Remedied Referred to H.M. Ins. Nuisances under the Public Health Acts:— Want of clean! iness 12 12 — — Want of ventilation 1 1 — — Overcrowding — — — Want of drainage of floors — — — — Other nuisances 23 23 — — Sanitary accommodation :— Insufficient 6 6 Unsuitable or Defective 15 15 — - Not separate for sexes — — — — Unscreened for Sexes — — . |
77973563-c470-4b83-ba9b-31d28de9f22e | — - Offences under the Factory and Workshop Acts :— Illegal occupation of underground bakehouse (S.101) — - Breach of special sanitary requirements for bakehouses (SS.97 to 100) 4 4 - - Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) - - - - Total 61 61 — — * Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. HOME WORK. Four notices were issued to the occupiers of premises in the district where outworkers are employed, who supplied lists twice during the year of 17 workpeople engaged on making wearing apparel in their homes. 44 REGISTERED WORKSHOPS. Workshops on the Register (Sec. 131) at the end of the year. (I) Number. |
4f33103c-e17c-46aa-be7a-7ecadec66e04 | (2) Bakehouses (including six factory bakehouses) 13 Other Workshops 66 Total number of Workshops on Register 79 OTHER MATTERS. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshop Act (Sec. 133) - Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Acts (Sec. 5) 5 Other 1 Underground Bakehouses (Sec. 101):— Certificates granted during the year In use at the end of the year - OUT-WORKERS. The following list shows the nature of the homework carried out in this district by 40 outworkers :— Box Makers 2 Wearing Apparel 16 Ties 5 Umbrella mnkers 2 Life belt covering 9 Boot Repairers 1 Art. |
0fba7f84-51ca-478c-880e-c4451dabafe9 | Flowers 1 Brush Makers 2 Upholsterer 1 Christmas Cracker Maker 1 During the year 30 lists of out-workers were received from other Authorities in respect of addresses in Barking. Four lists were received from employers within the district. In all instances the premises of out-workers were kept in a satisfactory state. 45 It is unfortunate that there is not a closer co-operation between the Home Office on the one hand and Local Authorities on the other hand in the matter of the inspection of factories. Indeed it is even more unfortunate that when the Ministry of Health was created, the medical inspection of factories was not delegated to the Minister of Health, who could very well have made regulations delegating his powers and responsibilities to Local Authorities whose organisations made them competent to carry out the work. This has been very amply illustrated in the case of asbestosis in Barking. In a later part of this Report I am dealing more particularly with asbestosis as a separate subject. HOUSING. |
fcf26df7-23d6-430c-9027-e0450dbe087a | The urgency of meeting the post-war shortage of houses resulted not only in municipal enterprise and state aid to private builders but also in a general improvement in the layout of the sites, reduced density of the dwellings and the provision of open spaces in connection with them. The houses erected in Barking are of the typical town street type with minimum frontage but substantial improvement in their character and design over pre-war buildings. An occasional touch of emphasis and variety, however, would have done much to relieve the monotony of vista in some of the new streets. Of all the changes which have taken place in house design, that with respect to the heating of the dwelling is the most noticeable and important. The growing realisation of the evil effects of the smoke and waste resulting from the use of raw coal in domestic fires is stimulating the adoption of alternative methods. 46 In this regard it is important for those erecting new houses to decide how far it is wise to commit themselves to one or another of the alternative methods of heating. |
b5102da0-2f83-4a97-90b1-9fb26dd6f06b | Whilst gas and electricity have advantages for temporary heating and local application, the general demand in future for continuous heating of rooms will be some form of improved smokeless fuel. The building of all gas or all electric houses is to be seriously deplored. The omission to provide flues to carry off the products of combustion, is unwise, and further, the absence of such flues leaves much to be desired in the matter of ventilation. In connection with gas heaters, particularly where it is imperative for safety that some form of direct outlet or flue should be provided, the sensible thing would be to build the flue so that it would equally well serve a coal fire. The year 1929 saw the erection of the first house on the Gale Street Section of the London County Council Estate, and the provision of a further 206 houses by the Barking Council. There was also an extension in the provision of houses for owner-occupiers to the extent of 237 erected. |
9d30e363-3ff2-4ec7-9063-a3f08d190edb | Whilst the erection of 206 houses by the Local Authority meant relief to many poor families living in overcrowded conditions, it was far from dealing adequately with the full situation. It is impossible, without taking a special census of the district, to estimate accurately the extent of overcrowding existing at the present time, but that it is extensive is borne out by information resulting from inspections by health officials and by receipt of complaints. The major reason for the overcrowding is the total absence in the district of accommodation for the poorer of the working classes, such as two or three-room tenements. 47 The result of the absence of such accommodation is that these families are compelled to occupy one room shut off from the rest of the house. Virtually one-roomed back-to-back houses, which are sometimes worse than the unfit houses scheduled for demolition. In this one room all the occupations of the day and night are performed. Parents and family have to rise, dress, wash, cook and cat their meals, etc. |
5b96fb41-d17d-4c47-bf4c-5fbd915c4b9e | A fire burns all day, winter and summer, as this is the only means of cooking and heating water. By the time night comes the whole family crowds itself again into one or two beds and attempts to secure what refreshing sleep it may in an atmosphere fouled and vitiated by the day's occupations. Many of these families consist of man, wife and children of mixed sexes and adolescent age. Under these conditions the preservation of cleanliness and bodily health are as difficult as the maintenance of modesty. Further, much of the good work which could be achieved with regard to child welfare must be largely thwarted and rendered abortive by the hopelessness of the surroundings into which so many of our babies are born. This may be reiteration of what has previously been written but I must repeat and emphasise it. |
e823716f-305b-4250-bac2-fe1e1ca5a025 | Although the Council has done such fine work in providing so large a quota of houses for the working classes, it is very urgent and imperative that much additional accommodation should be provided for the poorest of the poor, and it is my earnest hope that the Council will take advantage of the passing of the Housing Bill No. 2 to make an extension of their activities in this direction. GENERAL STANDARD OF HOUSING. The general standard of housing in the district is good for an industrial area. Apart from the old houses situated in certain parts of Abbey and Central Wards the dwellings are of a type and structure which permit of adequate lighting and ventilation, and were it 48 not for the growth of overcrowding referred to above, schemes for dealing with the small amount of slum property in the town could have been formulated. * The working-class houses in the district have the advantages of good wide streets and adequate back garden area, giving better external ventilation than is usually found in old industrial towns. |
2c95bb69-e792-46a8-9aa8-6bb3482086fc | The defects which are most frequently met with are indicated in the summary of sanitary work carried out. Our experience during recent years is that owners will not, owing to the altered economic conditions, carry out any major maintenance works, such as repairs to the external walls and woodwork of the houses, with the result that considerable decay of the structures of working-class houses is taking place and would inevitably lead to further slum dwellings but for the application of the Housing Act. There is not the slightest doubt, however, that many of the internal defects in houses are largely contributed to by the misuse and carelessness of the tenants, whose personal and environmental cleanliness is much to be deplored. There is ample scope for self-help in health, and the application of this by many of the citizens of Barking would enhance the general health of the community and stimulate the Local Authority to further efforts on their behalf. 49 SECTION 3. NOTIFIABLE INFECTIOUS DISEASES. |
2c82cac7-709c-4e04-8724-8f31d9e851f2 | The following table shows the number of notifications of infectious disease received during 1929 :— TABLE I. Males. Females. Total Total cases rem'd to Hos. Deaths. |
0bc33935-5540-4463-8b8a-16465d0339b2 | Small Pox 4 7 11 11* — Scarlet Fever 129 148 277 238 3 Diphtheria 43 52 95 89 4 Puerperal Septicaemia _ 1 1 — _ Pneumonia (Acute primary and influenzal & following Measles) 52 50 102 6 42 (All Forms) Erysipelas 21 15 36 5 Ophthalmia Neonatorum 12 2 14 Puerperal Pyrexia — 4 4 — — Enteric 3 — 3 3 — Anterio Poliomyelitis 2 1 3 1 — Cerebro Spinal Fever 1 1 1 1 Totals 266 281 547 354 50 These were removed to Orsett. One case was returned after one week, the diagnosis not being confirmed. |
95e66d9c-8ad0-40ad-a0d6-e76b44d452a5 | , 50 The following diseases were notifiable in 1929 under the original Infectious Disease (Notification) Act, 1889, and 1899 Small-pox, diphtheria, relapsing fever, cholera, erysipelas, typhus, plague, puerperal fever, enteric fever, scarlet fever and continued fever. and by Orders or Regulations framed under Section 180, Public Health Act, 1875 Tuberculosis (all forms), ophthalmia neonatorum, cercbro-spinal fever, acute poliomyelitis, encephalitis lethargica, influenzal pneumonia, acute primary pneumonia, malaria, dysentery, trench fever, and puerperal pyrexia. An order was made under the Infectious Disease (Notification) Act, 1889, making chicken-pox a notifiable disease throughout the district. |
685903d3-ccd5-498c-b3fd-3c1c7108a4e8 | The Barking Town (Pneumonia) Regulations, 1924, provides for the notification of Pneumonia supervening upon Measles. The total notifications of infectious disease numbered 547 exclusive of tuberculosis and chicken pox compared with 483 the previous year. During 1929 the number of notifications of tuberculosis (all forms) was 73 compared with 93 in 1928. 51—52 TABLE II. Notifiable Disease. No. of cases notified at age groups. Cases classified according to Wards. Under one year. 1 to 2 years. 2 to 3 years. 3 to 4 years. 4 to 5 years. 5 to 10 years. 10 to 15 years. 15 to 20 years. 20 to 35 years. 35 to 45 years. 45 to 65 years. Over 65 years. Abbey. Gascoigne. Central. Ripple. |
b39cb8d0-aba7-4700-86a3-cf8fd4da2959 | Longbridge. Westbury. Small Pox - - - - - 1 2 3 3 2 - - 1 1 6 3 — Scarlet Fever 3 11 15 17 14 119 56 19 20 2 1 - 44 28 23 60 58 64 Diphtheria 2 5 7 6 15 37 9 6 4 4 — - 19 27 10 14 15 10 Puerperal Septicaemia — — — — — — - — 1 — - - — - 1 - - — Pneumonia (primary, influenzal and following Measles) 2 5 7 3 3 11 4 7 16 16 24 4 24 19 11 12 24 12 Erysipelas — — — — — 3 1 2 6 7 12 5 |
3fd47e75-3fe6-4042-adaf-a60dd1075ee9 | 1 9 6 4 9 7 Ophthalmia Neonatorum 14 - - - - - - - - - - - - 3 4 4 2 1 Puerperal Pyrexia — — — — — — 1 3 — — — — 1 1 1 — I Enteric Fever - 1 — 1 — — 1 — — — 1 1 1 — Anterio Poliomyelitis 1 — 2 - - - - - - - - - - - - - - - Cerebro Spinal Fever 1 — — - — — — — — — - — - - 1 - - - Totals 23 21 31 26 32 172 72 39 53 29 40 9 88 90 59 103 112 95 53 TABLE III. Monthly summary of notifications of Scarlet Fever and Diphtheria received during 1929 : Scarlet Fever. |
15ad366f-e221-4fc1-aad1-d9aafe444948 | Diphtheria Total. January 37 6 43 February 21 6 27 March 21 2 23 April 11 3 14 May 11 5 16 June 8 3 11 July 19 4 23 August 22 7 29 September 26 9 35 October 42 9 51 November 38 18 56 December 21 23 44 Total 277 93 372 (a) Scarlet Fever.—The number of cases notified was 277 compared with 243 the previous year. Three fatal cases occurred. 238 cases were isolated at the local Infectious Hospital. The average stay of scarlet fever cases in the Municipal Hospital was 39 days, compared with 31.48 days in 1928. The longest period of detention was 119 days and the shortest 17 days. Sex.—129 cases were male and 148 female. |
f54f871a-8a7f-4461-800c-308d02cb6a48 | It is the practice to accept not only diphtheria but scarlet fever into the hospital at any time of the day or night at the request of the medical practitioners. 54 It is our intention, so far as practicable, still to carry out this general principle, but I do think that in cases of scarlet fever, where the retention of a case in the home until morning will not seriously increase the already very considerable possibility of other cases having been infected, medical men should always reflect before removing cases late at night. , Cases cannot be so removed Without incurring some danger to the patient, and unless this danger is compensated by the need for immediate treatment or on public health grounds, removals at night-time are difficult to justify. (b) Small-pox.—There were 11 cases of small-pox notified during the year under review. In one case the diagnosis was not upheld and the patient returned from hospital after one week. The rest were of a mild type and the situation was dealt with along orthodox lines. |
b4aa8ac3-af9d-44cd-8ed8-c02db6817f3e | In conformity with the usual practice, details of cases of small-pox have been consistently forwarded not only to the Ministry but also to neighbouring Authorities and to the County Council. It is curious that the County Council have taken upon themselves the onus of re-distributing this information over the name of the County officer. That the County officer would, naturally, wish to advise the officers under his direction and supervision is obvious, but his wholesale distribution of this information is less obvious. One would, naturally, expect the County Council to step in and carry out the work of a Local Authority if any question of default were to arise, and because this is so the present County practice appears to be difficult to explain. We still experience the curiosity of numbers of people waiting about the Town Hall to get their vaccination exemption certificates signed on the same evenings that the Health Committee is meeting to take measures—such as the notification of chicken-pox, etc.— to prevent the spread of smallpox. Vaccination does prevent small-pox. |
5597a733-b8fa-4a93-b688-9b63b0642d11 | I regret my experience teaches me it is necessary to reiterate this truth. 55 (c) Diphtheria.—95 cases were notified, compared with 107 the preceding year. Of cases notified, 89 were removed and treated in the local isolation hospital. 4 deaths from diphtheria occurred. The average stay of clinical diphtheria in hospital was 40 days, the longest stay being 98 and the shortest 3 days. Sex.—43 cases were male and 52 female. (d) Enteric Fever.—Three cases of enteric fever were notified during the year, all of which were removed to hospital. (e) Puerperal Fever.—One case was notified during the year, and was not admitted to hospital. The case recovered. (f) Puerperal Pyrexia.—Four cases were notified during the year. All of the cases recovered. (g) Erysipelas.—36 cases were notified during the year compared with 26 during 1928. |
1a2c900a-0ba1-4e8e-bef3-1cf9c9e289c8 | Five patients were removed to hospital. (h) Malaria and Trench Fever.—No cases were notified during the year. (i) Acute Primary and Acute Influenzal Pneumonia.—102 cases were notified dur ng 1929, compared with 74 for the preceding year. Six patients were admitted to hospital. (j) Encephalitis Lethargica.—].12 No cases were notified during the year. (k) Chicken-Pox.—In view of the prevalence of small-pox in surrounding districts, chicken-pox was made a notifiable disease in the district in April, 1928, and continued to be notifiable throughout 1929. A total of 414 cases were notified during the year, compared with 303 during 1928. Sex.—213 were male and 201 female. (II) NON-NOTIFIABLE INFECTIOUS DISEASES. The most important of these are measles, whooping cough and summer diarrhoea. |
6671a9e9-2cee-422b-91e9-2f49d6b1b714 | There were no serious epidemics of these diseases, and the deaths registered were as follows :— Measles Whooping Cough Summer Diarrhoea 10 56 Measles and Whooping Cough.—Cases amongst school children are reported to the School Medical Officer by school teachers, attendance officers and nurses, appropriate action being taken as regards exclusion and supervision of contacts. ISOLATION HOSPITAL. The following is the table of admissions, etc., in respect of infectious diseases during 1929 :— Disease. In Hospital January, 1st, 1929. Admitted during the year. Died. Discharged In Hospital Dec. 31st. 1929. |
da03ba17-01c8-4ab0-8bcf-249591c560b9 | Scarlet Fever 28 238 2 242 22 Diphtheria 10 89 5 63 31 Pneumonia - 4 2 2 - Puerperal Fever - - - - - Arthritis 1 - - 1 - Enteric Fever - 2 - 2 - Erysipelas - 3 - 3 - Miscellaneous - 9 2 7 - TUBERCULOSIS Adminstrative Arrangements.—The policy of your Medical Officer of Health acting also as Tuberculosis Officer for your district under the County has been continued during 1929. Towards the end of that year a conference was held at Black Notley, at which, amongst other things, the question of if and whether this is the best policy was discussed. The alternative to your present practice is for a whole-time Tuberculosis Officer to be appointed for a larger area. Dr. |
b46ef343-3ae4-47ec-994e-217e66d1d6e6 | Williamson, of the Ministry of Health, who appeared rather to favour this alternative, made out the strongest case I have ever heard for the combination of duties. 57 In outlining his conceptions of the duties of a Tuberculosis Officer, Dr. Williamson laid great stress on the necessity of the Tuberculosis Officer making himself conversant with all the social, economic and industrial factors which play such an important part in the lives of their patients, and, as I pointed out at the conference, to all intents and purposes Dr. Williamson was demanding that each Tuberculosis Officer should be in fact a Medical Officer of Health, which, of course, is the same thing as saying that a Medical Officer of Health should be the Tuberculosis Officer. |
4da5471f-a627-4ac5-8018-2028662a4643 | It is obvious that for any Medical Officer to establish contact with all the various activities and social influences which affect the health of the people under his care, he must be in a position to have personal knowledge of the other work which is being undertaken in public health, such as housing, inspection of workshops, maternity and child welfare, etc., and it is essentially the Medical Officer of Health who unites in one office a direct personal interest in all these various activities. It may reasonably be assumed that this work will double itself in the next three years, so that we shall then have enough work for two-thirds of the time of a whole-time Medical Officer. My experience is that this work is best undertaken by a parttime Medical Officer. |
3efa0b7e-1c2b-4a91-b255-23958ef427ad | The administrative arrangements for dealing with tuberculosis in the area include :— (a) A dispensary used on two half-days per week, (b) Garden shelters for suitable cases, (c) Sanatorium accommodation for surgical tuberculosis, (d) Sanatorium accommodation for suitable early pulmonary cases, and in some instances the more advanced, (e) Accommodation for a number of bedridden and advanced cases at St. Joseph's Hospice, Hackney, and Liverpool Road Hospital, Islington. The number of notified cases on the register on December 31st, 1920, was 737, compared with 990 for the corresponding period of the preceding year. 58 During the year, 64 notifications were received of all forms of tuberculosis—pulmonary 48, and non-pulmonary 16. Information was received of the removal into the district of six tuberculous persons, included in number of notifications received. Forty two deaths of notified cases occurred. |
02d0a293-1310-4635-b5f1-cd1bfde6ecf3 | Particulars of new cases of tuberculosis notified and of deaths from the disease during 1929 is afforded by the following table New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Male . Female. Male. Female. Male. Female. Male. Femals. |
0a1b48b8-6c4a-4570-993b-749e0cca6dc6 | Under 1 year — — — — — — — — 1 to 5 years — — 3 — 1 — 1 — 6 to 10 years 1 — 4 4 — — - — 10 to 15 years — 1 — 1 — — — — 15 to 20 years 3 6 — 2 1 2 — — 20 to 25 years 3 3 — — — 7 1 — 25 to 35 years 5 10 1 — 1 3 — — 35 to 45 years 7 1 1 — 9 1 1 — 45 to 55 years 2 1 — — 4 1 — — 55 to 65 years 4 1 — — 3 1 — — 65 yrs. |
c01e87ae-91ae-4ed4-8c6c-894b5a559a3b | & upwards — — — — — 1 — — Totals 25 23 9 7 19 16 3 — PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. These regulations came into force on the 31st July, 1925 Under certain circumstances you can, in accordance with Section 62, isolate by compulsion persons who are likely to spread tuberculosis. 59 During the year it has not been found necessary to take action under these Regulations, but your expressed intention to use Section 62 of the Public Health Act, 1925, has been helpful to us on several occasions and fortunately we have been able to deal with many cases on a voluntary basis. It cannot be over emphasised that the control of the tuberculous subject is at the present time your most powerful weapon in combatting consumption. The following are particulars of cases notified under Forms C and D during the year:— Form C. Form D. Pulmonary. |
b8fbdfe1-57e9-4dc0-9073-a7273932e4b6 | Non-Pulmonary Pulmonary. Non-Pulmonary. Male. Female. Male. Female. Male. Female. Male. Female. 27 18 3 4 17 20 1 2 Thirty-eight deaths occurred from tuberculosis (all forms,) 35 of these being pulmonary cases. The number of deaths in institutions was 17. The death rate for tuberculosis (all forms) during 1929 was 0.9, compared with 1.1 for the previous year. There were 944 attendances at the dispensary during the year for the purpose of medical examination, 221 being new cases. Of new cases attending during the year, 37 were subsequently notified as suffering from tuberculosis, 56 had been previously notified, while 6 were inward transfers. |
eb1968a0-c115-478b-a8eb-440af24e441e | It will appear from the figures quoted that the number of new cases seen at the Dispensary for the first time and which have been previously notified is considerable, and unless this is explained it "light perhaps lead one to suppose that the Dispensary is dealing with cases already notified and is not being used largely as a consultative centre where cases are seen previous to notification. 60 As a matter of fact, of the really new cases, the vast majority are seen at the Dispensary before notification, but there are a lot of old cases notified years ago which are only coming to the Dispensary for the first time now, and their numbers swell the number of, new cases previously notified attending for the first time, although in reality they are not new cases at all from the standpoint of the patients themselves. These old new cases, if I may call them so, are attending the Dispensary in large numbers because we are following them up intensively with the object, where possible, of removing their names from the Notification Register. |
96819d2a-9dbd-4ae7-a2bf-3dfc5afdbfeb | The following table gives in tabular form the number of patients removed from the Dispensary Register during the year :— No. on Dispensary Register 31-12-28. Numbers removed from the Dispensary Register. Number on Dispensary Register 31-12-20 Died. Left District. Discharged (Non Tb.) Discharged " Cured" Transferred to another Dispensary, etc. Amended Diagnosis Total 511. 35 20 166 47 12 50 330 423 At the end of the year, 397 cases on the Dispensary Register were definitely diagnosed as suffering from tuberculosis, whilst in 26 cases the diagnosis still remained in abeyance. REGISTER OF TUBERCULAR PERSONS. Last year I said " This register, I am of opinion, is misleading." |
88c2e9a4-5b9d-4d9d-b8b1-2a95e4228cae | It has been my very best endeavour to do what I can to bring this register up to date, and, although much work remains to be done, the following table shows that much has been done and the register is far more valuable now than it was a year ago. 61 On Regst. 31-12-28. New cases during year, Died. Cured. Left district. Amend. diagnosis. Other. Total rem. from reg. On Reg. |
c70840e3-2708-41e6-a976-eabb90550715 | 31-12-29 Pulmonary— 669 48 86 41 46 39 1 213 504 Non-Pul.— 321 16 9 35 40 20 - 104 233 Total 990 64 95 76 86 59 1 317 737 At the inception of the Tuberculosis Service in England the scientific diagnosis of this complaint had already reached a remarkable level of attainment, but the years that have passed since then have so very considerably increased our knowledge that already the data on which these diagnoses were made are looked upon as out of date. |
5e3560e4-a1fe-48b0-8e02-b9bab3d86626 | The whole situation is further complicated, as I have pointed out elsewhere, by the fact that from a strictly scientific standpoint a very large proportion of the whole population have at some time or another suffered from tuberculosis of one form or another, whilst consumption from a practical standpoint is not nearly so common as such a scientific survey would indicate, because when we speak of consumption from an administrative standpoint we mean that the health of the patient is or is likely to become bankrupt by reason of this disease. It will not therefore be surprising for me to say that in going over the Tuberculosis Register we have found a large number of persons who have been notified on evidence we should not now look upon as conclusive. The register, too, has now been going a sufficient number of years for a large number of persons very happily to have been cured. Work has been done during the year 1929 removing such persons from the register. |
d2cd114e-d1c2-4726-8312-7b381f5c9835 | It is necessary to be very sure such removals are quite proper before they are made, and these removals involve a lot of time administratively and in correspondence. 62 There have been 317 removals this year, so that although the population has on the whole grown, the number of persons on the Tuberculosis Register has declined from 990 to 737. AFTER-CARE. Tuberculosis in the great majority of instances is a curable infection provided the patient is seen sufficiently early, undergoes sanatorium treatment and subsequently is able to pass his life under reasonably hygienic conditions. It is with regard to the latter that the activities of the After-care Association in this district particularly exist, consisting inter alia in providing special splints, clothing, boots, nourishment, etc., for necessitous cases and in obtaining, if possible, suitable homes and employment for the tuberculous. ASBESTOSIS. |
b96aad50-d2d1-41c1-85da-18feba564eaa | During the year 1929 research has been continued into the question of fibrosis of the lungs due to the inhalation of particles of asbestos. In June 1929 an interim report was circulated to members of the Council at the request of the Juvenile Employment SubCommittee. In this interim report a table was given, showing that of nineteen cases of persons suffering from some pulmonary disability and who had been exposed to asbestos dust, there was sufficient evidence to warrant a diagnosis of asbestosis in eight, no sufficient evidence to warrant a then present diagnosis in nine, whilst there were two cases at the time in question awaiting further examination. The same report included five conclusions, which in my opinion had been established up to that time, viz. :— (1) That people working in asbestos factories inhale asbestos dust, which can be found in the substance of the lung proper and in the sputum which is exuded from the bronchi of the lungs. |
716b4431-451a-411f-93ce-ab98a0fd2c6d | 63 (2) That the presence of this asbestos dust in the lungs produces a definite disability, adversely affecting earning capacity and decreasing the expectation of life. (3) That it is possible for an exposure to asbestos dust over a period of six months to produce a definite disability lasting over man}' years. (4) That there is not sufficient evidence to warrant an opinion on the question of the possible increased incidence of tuberculosis in persons who are suffering from asbestosis. (5) That these conclusions indicate that the conditions under which certain of these cases have been working have been such as to permit the inhalation of asbestos dust, with consequent pulmonary disability. |
97a21f60-d5d9-4e30-a282-821931096e27 | From the time of the interim report to the end of the year the research into this matter has been continued, so that, amending the table of persons investigated, we have at the end of the year 23 cases investigated, 9 of which showed sufficient evidence to warrant a diagnosis of asbestosis, 10 of which showed no sufficient evidence at that time to warrant a diagnosis of asbestosis, and 4 of which were awaiting further investigation. At about the beginning of December one of the cases included in this table died. On the instruction of the coroner an inquest was held with a jury, and the jury brought in a verdict of death from "asbestos poisoning." It may almost be considered that if the report of June was an interim report, as suggested then, the coroner's verdict was a final report, because the case was one of the earliest, and the verdict rested upon the evidence which had been collecting for two years. |
183a88f4-6fe0-4291-b556-96df15d36d56 | Since writing this Report on asbestosis in June 1929 I have had the advantage of consultations with other people who are interested in this work, and whilst it is still true that our own series 64 of cases does not afford sufficient evidence to warrant an opinion on the possible increased incidence of tuberculosis in persons who are suffering from asbestosis, I understand from my conversations it is true that the evidence as a whole suggests that persons suffering from asbestosis are more likely than other people to suffer from tuberculosis. The work I have been carrying on in this connection convinces me more than ever we shall never get an efficient complete medical service in England until the whole of the public medical services are united under one Ministry. The fact that the health of workers in factories is under one Ministry and the health of these same workers outside the factories is under another Ministry is essentially bad. During the year 1929 there have been three deaths in Barking attributed to asbestosis. |
a54bf859-2b09-4089-b335-bfae20dcbbf8 | Two cases were well known to us, and the deaths of these persons were the subject of an enquiry by the Coroner. Another case of asbestosis died during 1929, and the cause of death was given as " Bronchitis." Of course this notification is quite correct, but in my opinion it does not represent the whole of the truth. 65 SECTION 4 MATERNITY AND CHILD WELFARE. The Council's Scheme under the Maternity and Child Welfare Act, 1918, has been extended during the year. The use of the Artificial Sunlight Clinic, working in co-operation with the Infant Welfare Clinics, continues to be attended with good results. REGISTRATION AND NOTIFICATION OF BIRTHS. By the Registration Act, 1836, all live births must be registered within a period of six weeks. The actual number of live births within the district during the year was 766, the net total of 787 being obtained by adjustment of inward and outward transfers, etc. |
80070cc3-aacb-489a-9c8f-f4da93a16a48 | The births registered included 398 males and 389 females. There were 14 illegitimate births, or 1.8 per cent. of the total. In comparison with 1928, 18 less births were registered during the year, a fall equivalent to 2.2 per cent. By the Notification of Births Act, all live births and still-births of seven months and over are required to be notified to the Medical Officer of Health within 36 hours. Of the total live births all except 16 or 2.2 per cent. were notified. In addition 6 still births were not notified. The following table gives details of the notifications received :— By whom notified. Live Births. Still Births Medical Practitioners 136 2 Certified Midwives 486 17 Parents and Others 91 1 The percentage of still-births was 2.8 66 Of the total live births during the year 414, or 56.8 per cent. |
e308f99c-7dd8-46fb-a19a-d2568b2c5530 | were attended by midwives, the remainder being attended by medical practitioners. BIRTH RATE. The birth rate for the year was 18.7, compared with 16.3 for England and Wales. MATERNITY AND INFANT WELFARE. The Ante-Natal Clinics. The work of the Clinics was carried on as in previous years, and one extra session was commenced at the Alexandra Clinic in August, 1929. The attendances during the year were well maintained. The number of primary attendances was 386, compared with 398 for 1928. Reattendances numbered 1,180 in 1929, and 1,063 during 1928. One hundred and twenty-three sessions were held during the year, making an average attendance of 12.5 mothers per session. Expectant mothers attending the Ante-natal Clinics are drawn from the following classes :— (a) Patients intending to enter the Upney Maternity Ward for confinement. |
64fd2901-0fcb-4a9f-8201-7057d71b771b | (b) Those engaging with the midwives of the Plaistow Maternity Charity. (c) Patients engaging with private midwives. Post Natal Cases. Twenty-three cases attended by midwives were referred by them or by the health visitors for examination at the Ante-natal Clinics owing to the presence of defects following childbirth. 67 MATERNITY WARD. The admissions to the Maternity Ward of the Municipal Hospital numbered 180, compared with 200 in 1928. Of these 36 cases were admitted for ante-natal treatment, and 144 for confinement. Corresponding figures for 1928 were 29 cases for ante-natal treatment, and 171 for confinement. (1) Number of cases admitted 180 (36 of which Ante-natal) (2) Average duration of stay 14. |
aed932c1-ac75-4cb0-8039-d4920b832db7 | 26 days (3) Number of cases delivered by :— (a) Midwives 142 (b) Doctors 2 (4) Number of cases in which medical assistance was sought by the midwife with reason for requiring assistance:— (a) Ante-natal 1 Unsatisfactory condition of mother (b) During Labour 1 Uterine Inertia (c) After Labour 6 Torn Perineum (d) For Infant — (5) Number of cases notified as puerperal sepsis with result of treatment in each case Nil (6) Number of cases notified as puerperal pyrexia with result of treatment in each case Nil (7) Number of cases of pemphigus neonatorum Nil (8) Number of cases notified as ophthalmia neonatorum with result of treatment in each case Nil (9) Number of cases of " inflammation of the eyes," however slight Nil (10) Number of infants not entirely breast fed while in the Institution, |
e0619bbd-9dbc-479b-a897-7ebbaf25b203 | with reasons why they were not breast fed 2 (a) Weakness of mother 2 (b) Premature Infant Nil (c) Partially fed—delicate mother Nil 68 (11) Number of maternal deaths Nil (12) Number of foetal deaths (a) stillborn, and (b) within 10 days of birth and their causes—and the results of the post mortem examination if obtainable:— (a) Still-born 5 (b) Within 10 days of birth (Premature) 1 (Died 14 hours after birth) PUERPERAL FEVER AND PUERPERAL PYREXIA. On October 1st, 1926, the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926, came into force. |
7fff18bb-334d-4e4a-97af-dbeb76b92527 | These regulations require the notification of puerperal pyrexia (according to the definition given in the regulations), in addition to those cases previously notifiable as puerperal fever under the Infectious Diseases Notification Act, 1899. In a circular accompanying the Regulations, the Minister of Health urges local authorities to exercise the powers conferred on them under the Maternity and Child Welfare Act for provision of facilities for diagnosis, skilled nursing at home, or institutional treatment, if in the opinion of the medical practitioner in charge of the case any one of these is necessary. In accordance with this direction, arrangements have been made by the Council for nursing of the patient at home, or in the isolation hospital as desired. In addition, Dr. A. Kennedy has been engaged as consultant for those cases in which a second opinion is required by the medical attendant. One case of puerperal fever was notified as compared with 2 in 1928. |
31d00998-2271-46a7-8239-9967adf105a7 | The patient was isolated immediately on the onset of pyrexia, and no further cases occurred. In addition to the cases of puerperal sepsis, 4 cases of puerperal pyrexia were notified, the confinement in 2 cases being attended by a midwife. All the patients recovered. 69 MATERNAL MORTALITY. Two maternal deaths occurred during 1929, the deaths being certified as follows:— (a) Cardiac failure 1 (b) Syncope 1 NEO-NATAL MORTALITY. The number of deaths of infants under four weeks of age was 28, compared with 24 for the previous year in Barking. STILL-BIRTHS. Of the total notifications received under the Notification of Births Act, 20 related to stillborn children, giving a percentage of 2.8 compared with 1.7 in 1928. In addition, 6 still-births were not notified. |
4413d349-6563-42dc-89d9-3c34c9506519 | Investigation of the health visitors elicited the following information (1) Duration of pregnancy:— (a) Less than seven months 2 (b) More than seven months 19 (c) Not elicited 5 (2) Presentation:— (a) Vertex 9 (b) Breech 7 (c) Transverse – (d) Not elicited 8 (e) Footling 1 (f) Monster 1 (3) Supposed cause of stillbirth:— – (a) Abnormal presentation – (b) Overwork – (c) Accident, etc. 5 (d) Not known 16 (e) Ill health 3 (f) Shock 1 (g) Worry 1 (4) Occupation of mother:— All the mothers were engaged in household duties at home. 70 OPHTHALMIA NEONATORUM There was a decrease in the number of cases of ophthalmia neonatorum, notifications being 14, compared with 15 in 1928. |
047692ff-ae9d-4ca9-b317-c57d1eb9af09 | 8 of the cases occurred in the practice of midwives, the remainder being attended by medical practitioners. Age Group. Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths. Notified Treated. At Home. At Hosptl. Under 3 weeks 14 14 – 14 – – – The growing appreciation among midwives of the seriousness of the condition and of the value of early treatment makes for a greater readiness on their part to call in medical help to the slighter cases of discharge which previously may have escaped notification altogether. OPHTHALMIA NEONATORUM REGULATIONS, 1926. These regulations came into force on October 1st, 1926. Under them it is no longer the duty of the midwife to notify cases. in accordance with the rules of the C.M.B. |
a0589709-3b6c-4691-9093-e74442b8c5fe | the midwife is under obligation to call in medical aid for any inflammation of the eyes, and the onus is now with the medical man called in to notify if, in his opinion, the case is one of opthalmia neonatorum. For the effective supervision and treatment of such cases, close co-operation between the Local Supervising Authority and the Local Sanitary Authority is essential, and suggestions are made in a circular accompanying the Regulations as to how this co-operation may best be secured. 71 INFANT AND CHILD WELFARE. Work of the Health Visitors and the Infant Clinics. An analysis of the attendance at the Infant Welfare Centres is piven in the following table:— Infant Welfare Centres. Clinic Premises Alex. Centre Movers Lane Total No. of sessions 104 100 100 304 No. |
261e7eab-2fe5-4e6e-8b24-80774d0966c2 | of attendances of children under one year:— (a) New cases 206 138 126 470 (b) Old cases 2530 1835 1693 6058 No. of attendances of children 1 to 5 years of age:— (a) New cases 37 29 20 86 (b) Old cases 953 1554 1043 3550 Average number of attendances per session 36 35 29 33 No. of sessions attended by medical officers 104 100 100 304 No. of children seen by medical officers (a) Under one year 1588 1179 1063 3830 (b) Over one year 619 818 774 2211 Average number of children seen by medical officer per session 21 20 18 20 The total attendances during the year were 10,164 as compared with 8.561 in 1928. |
70506f21-4e5e-41f7-89c3-ec508cfa3888 | Particulars of the home visits paid by the health visitors is given in the following table No. of ante-natal visits 106 No. of first visits to children under one year 730 No. of subsequent visits to children under one year:— (a) Attending a Centre 281 (b) Not Attending a Centre 2,943 No. of visits to children 1 to 5 years of age (a) Attending a Centre 225 (b) Not Attending a Centre 3,523 No. of special visits in connection with Ophthalmia Neonatorum 19 Ditto Deaths of children up to 3 years of age 49 Ditto Still-births 23 Ditto Puerperal sepsis and Pueperal Pyrexia 5 Ditto Foster Children 24 Other visits (not specified) 117 72 THE PRE-SCHOOL CHILD. |
917b7ba8-e6ae-4967-996a-77b77358d858 | Treatment may be obtained for children attending the infant welfare clinics as follows :— Minor Ailments.—Treatment is given at the Central Clinic. Dental and orthopaedic treatment, and treatment of septic tonsils and adenoids are available. Convalescent Treatment.—This is provided for under the Schcme, and is of value for children suffering from debility following acute illness. During the year a Refraction Clinic for toddlers has been inaugurated and is doing useful work. FOSTER CHILDREN. All cases of foster children resident in the district are notified by the Guardians to the Medical Officer of Health under the Children Act, Part 1. Twenty-four notifications were received during the year, and special visits were made by the health visitors to these children, who are also kept under supervision by the Infant Life Protection Visitor. |
65f2a6d1-0e5f-4f44-9110-62dd6e509538 | Fortunately for many years accurate records have been kept in the Public Health Department of all foster children in the district, so that the work devolving on us in 1930 (under the Children Act, 1908), will not be new to the department. INFANTILE MORTALITY. The total number of deaths of infants during the year was 42, giving an infant mortality rate of 53.4 per thousand registered births, compared with 63.3 per thousand for 1928. ILLEGITIMACY. Fourteen illegitimate children were born during the year, and in the same period 5 deaths of illegitimate infants occurred; the infantile mortality rate among these children was therefore 357.1; while that for legitimate infants was 47.9. DENTAL CLINIC. |
594991ae-b98a-4a0c-a815-01bbd0f8ed99 | A general increase in this branch of the work has been taking place, and during 1929 the attendances of expectant and nursing 73 mothers arid of children referred from the Maternity and Child Welfare Clinics were as follows:— (1) Number of children treated 238 (2) Number of mothers treated :— (a) New cases 117 (b) Old cases 425 (3) Number of dentures supplied 65 Ninety sessions were held. Here it must be observed that the aim of the Maternity and Child Welfare Service is the prevention of the onset of dental caries in the child, and, for this purpose, the improvement of the health of the mother and of her diet during pregnancy, the encouragement of breast feeding and the use of suitable dietaries for the young child, together with the practice of mouth hygiene, are all factors which must be dealt with by the Maternity and Child Welfare staff, in order to bring about an improvement in the structure of the teeth, and delay in the onset of caries. |
7913a1d9-cb29-4691-9d45-9780cf93fb74 | ORTHOPAEDIC CLINIC. Twenty-seven children under school age were referred from the Infant Welfare Clinics or by the local medical practitioners for examination by the Orthopaedic Surgeon during the course of the year, and, in addition, 86 cases attended for re-examination. Two of the children received in-patient treatment at Orthopaedic Hospitals. |
eaee39eb-e895-4ab7-9cd6-871d95eec213 | The cases dealt with for the first time during 1929 were referred for the following conditions:— Deformities—Bones and Joints— (a) Congenital: (i) Digits of Hand 1 (b) Acquired: (i) Genu Varum 1 (ii) Genu Valgum 3 (iii) Hallux Valgus 1 (iv) Digitis Varus 1 (v) Bow Legs 1 8 74 Muscular Deformities— (a) Congenital: (i) Talipes 4 (ii) Torticollis 3 (iii) Subluxation of Shoulder Joints 1 (iv) Lower Limb, |
7e8e0f7c-8570-47ec-910a-0778b7988c0c | short and small 1 (v) Outward Rotation of Humerus 1 (b) Acquired: (i) Pes Planus Valgus 6 (ii) Abnormal Gait 1 17 Paralysis— (a) Congenital: (i) Spastic Hemiplegia 1 (ii) Spastic Diplegia 1 (iii) Erb's 1 (b) Acquired: (i) Paresis of Neck Muscles 1 4 Congenital Deformities—Nil. Total 29 ARTIFICIAL SUNLIGHT CLINIC. The treatment of infants and children under five years of age at the Artificial Sunlight Clinic was continued during 1929. Cases are referred by the medical officers in charge of the Infant Welfare Clinics, and the children attending are kept under constant medical supervision during their course of treatment. The majority of the children referred for treatment were suffering from early rickets and malnutrition. |
3ee7718e-16cd-441e-9e5d-fcb91178e24a | In addition, cases were referred for the following conditions—chilblains, prematurity, general debility, and anaemia. In all, 95 children received treatment during 1929. One session per week was devoted to these cases, and 725 treatments were given. 75 MEALS TO EXPECTANT AND NURSING MOTHERS. Advantage has been taken during 1929 of this provision under the Act. The total number of dinners supplied was 371. The nutrition of the mother during pregnancy and in the lying-in period has a very important bearing on the well being of the infant, and it is at these times that necessitous mothers are particularly encouraged to avail themselves of the Council's scheme. PROVISION OF FRESH MILK. Particulars of the amounts of wet milk supplied free and at reduced rates to necessitous mothers and children are given in the following table:— No. of pints supplied at reduced price. No. of pints supplied free. |
b1eda135-e01f-4b2a-b021-43471ca963b2 | Total. Total cost of milk supplied. Council's liability in respect of fresh milk supplied. f 9. d. f s. d. 1,881 8,880 10,761 149 3 7½ 136 1. 8 PROVISION OF DRIED MILK, Etc. Particulars of the amount of Dried Milk, etc., supplied free and at reduced rates, are as follows :— Cost Price, (lbs.) Reduced Price, (lbs.) Free, (lbs.) Total, (lbs.) |
70b6fe66-2196-4e4e-a23e-eeb2e1471b0f | Glaxo (Humanised) 595 31 92 718 Ambrosia 641 164 610 1,415 Cow and Gate 2,497 517 1,251 4,265 Ostelin 3 Nil Nil 3 Lactogol 125 Nil Nil 125 Virol 663 9 13 685 Parrish's 147 Nil Nil 147 Paraffin 136 Nil Nil 136 Malt and Oil 385 1 88 474 Vitoleum Cream 1.163 Nil 4 1,167 Pure Oil 276 Nil 11 287 Trufood 2 Nil 2 4 76 To the Medical Officer of Health. From the Public Dental Officer. Sir,— I have the honour to submit the Report on the Dental Service for the Maternity and Child Welfare Scheme for the year ending December 31st, 1929. |
305f9cf2-a3c1-4f0a-975c-e988ae795304 | During the year the administration of the service has been under the care of three consecutive dental officers, but the changes apparently have not disturbed the efficiency of the scheme. Professional views differ in the matter of dental treatment as in other branches of the healing profession, and where some are insistent on conservative treatment their colleagues are equally insistent that radical treatment is the only effective method of protecting the health of the patient. Both are right, and it is the judicious combination of the best of both methods with due consideration of the patient's environment and habits, that makes for the greatest success at the present stage of public dental education in this country. An expectant mother, careless in personal habits, already possessing a family of size, usually will not tolerate conservative treatment, and unfortunately her own wish for the removal of affected teeth is the only possible line of treatment that is of any healthful service to her. |
fa6d77f5-f028-4896-b244-524f23d1a796 | On the other hand a young mother who still retains the influence of the lessons in hygiene now given in school will consent to aid the Dental Surgeon in an endeavour to clear up an unhealthy mouth by faithfully following advice as to home treatment. As the girl children of to-day are the potential mothers of tomorrow the greatest aid to any maternity and child welfare scheme is to teach hygiene, and to teach NOW, while the future mother is of school age. 77 It has been the custom at this Clinic in the past to allow 6 months to elapse after multiple extractions before the fitting of dentures. Thus patients receiving treatment in the latter half of the year will not be shown as receiving dentures in the figures below. There has been considerable increase in the number of under-age children treated, the number being doubled as compared with last year. The administration of nitrous oxide gas by nasal apparatus has proved of considerable advantage both to the patient and the operator. |
c0d17d14-bf2d-4445-8806-80fe98585069 | In conclusion, the improvement of the service and the gratifying improvement in the number of patients is in no small measure due to the sympathetic activities of the medical officers concerned, the Health Visitors and the Nursing Staff; but it should be borne in mind that the service to be complete should be one in which dental treatment is a compulsory benefit for those seeking the other advantages offered by the Maternity and Child Welfare Scheme. I have the honour to be, Sir, Your obedient servant, W. H. FOY, L.D.S., R.C.S., (Eng.). 78 DENTAL CLINIC. Maternity and under-age Cases. 1929. 1. Number of children treated 238 2. Number of mothers treated:— (a) New Cases 117 (b) Old Cases (Clinic Attendances) 425 *3. Number of dentures supplied 65 4. No. of Fillings Mothers 19 40 Children 21 5. |
559e1b45-657d-4873-8019-45a0fcd96e82 | Number of sessions held 80 *In addition to the 65 Dentures actually supplied, 18 were recommended for such treatment, which was not obtained for the following reasons:— Apparently not wanted 10 Lack of money 5 Left District 3 Total 18 79 SOME ECONOMICS RE INVALIDITY AMONGST RE-HOUSED POPULATION. The establishment of a dormitory population in Barking under the advantageous circumstances of recent housing development by the London County Council and otherwise, represents a phase of one of the greatest experiments of all time. The benefits of these people living in houses which can be well ventilated, which houses themselves are in well-ventilated areas, are beyond estimation, but a note of warning must be raised depreciating any highly optimistic views which may be held as to the purely economic value of this improved health. |
849eaafc-afb4-4148-b434-8c2b94eca669 | Whilst it is confidently expected that the average number of periods of invalidity amongst the re-housed population will be less than when they were housed under their previous adverse circumstances, it will nevertheless obtain that the period of each individual invalidity may be longer than a comparable invalidity when the patient was living, so to speak, right on top of his work. Whereas with people living near their work it is conceivable that they return to work so soon as their physical condition enables them to carry out that work, it will be necessary amongst the re-housed population that they shall not only be able to undertake the physical strain of the work itself but the very considerable strain also of the daily journey to and from their work. This places the Health Insurance at an economic disadvantage, which cannot well be controlled by the regional medical officer. because in each individual case the few days or weeks involved can hardly come within the purview of his work and can hardly be the subject of a deposition by him. |
b261106b-1e2c-4464-aa57-50fe2d9b74e4 | The case of a person suffering from tuberculosis is an extreme example of the way in which re-housing people in suburban dormitories is likely to influence adversely the funds of Health Insurance. 80 The regional officers responsible for determining the continuance or otherwise of monetary benefits already take into their province not only the medical aspect of the case but the nature of the work the person habitually carries out. In this latter consideration it will now be necessary for them to take into their consideration the distance the person has to travel in order to obtain suitable work, and although this factor has been more or less ruled out of order in the past it is one which will have to be very seriously considered in the future. In November of 1929 I had the pleasure of a consultation with Dr. Cross of the Ministry of Health on this very question, and I am hopeful that the question of where work can be obtained will in future be given as great a prominence as the question of what work can be obtained. |
571792ae-7b36-4814-8f30-685cbceac70b | BARK 71 Barking Town Urban District Council. THE ANNUAL REPORT OF THE School Medical Officer For the Year 1929 C. LEONARD WILLIAMS. B.Sc., M.R.C.S., L.R.C.P., D.P.H. 2 SCHOOL MEDICAL STAFF, 1929 School Medical Officer i C. LEONARD WILLIAMS, B.Sc., M.R.C.S., L.R.C.P., D.P.H. Deputy School Medical Officer : MURIEL J. LOUGH, B.Sc., M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. (Died May, 1929). J. GWEN BEVAN, B.Sc., M.R.C.S., L.R.C.P. Orthopaedic Surgeon : B. WHITCHURCH HOWELL, M.B., B.S., F.R.C.S. |
6be94405-0073-4695-86d0-5b86650555e5 | Radiologist : ANGUS E. KENNEDY, M.R.C.S., L.R.C.P., L.S.A. Dental Surgeon : H. S. SMYTH, L.D.S., R.C.S. (Eng.) (Resigned August, 1929). W. H. FOY, L.D.S., R.C.S. (Eng.) (Commenced November, 1929). Masseuse : Miss A. E. FINDLAY. C.S.M.M.G. Nurses : Miss L. F. SWAIN. Miss S. E. W. GIBSON. Miss G. GEDEN (Dental Nurse). * Clerical Staff: E. W. HILL (Chief Clerk). D. G. TONKIN. Miss V. SHEAD. Miss H. NUNN. Miss H. KING. * ½ of Salaries charged to School Medical Service. |
374de912-e074-4607-859d-e5512e4c8273 | 3 Barking Town Urban District Council, PUBLIC HEALTH OFFICES, BARKING,. ESSEX. June, 1930. To the Chairman and Members of the Local Education Authority. Mr, Chairman, Ladies and Gentlemen, Herewith I beg to submit for your favourable consideration my report on the public medical services which are carried on by you, for the year ended 31st December, 1929. The opening months of 1929 found you face to face with one of the most pathetic troubles you have been called upon to encounter. Dr. Lough, whose name in Barking was a by-word for everything that was honest and homely and thorough, succumbed to an illness which had been threatening her for the past few years, and her death removed from amongst you one whose place it will be impossible to fill. « ... Dr. |
a9ac249d-87b9-471e-b495-47b8ed6ba248 | Lough had not only had a very thorough training in medicine and particularly in those aspects of medicine in which she had specialised, she had also a much wider training in many aspects of life, and her outlook on her duties and responsibilities was correspondingly comprehensive, added to which she had a predilection for hard work. 4 Together with the members of the Committee who knew her personally, I feel I have indeed lost something more than an ideal colleague. I have lost a real friend. It is, however, fortunate that during the time of Dr. Lough's last illness we had with us Dr. Bevan, who was already working part-time in Barking and who was intimately acquainted with the' work Dr. Lough had been carrying on. The Council decided to appoint Dr. Bevan to the vacant post, and Dr. Bevan, 1 know, leaves no stone unturned to merit the great confidence which has been reposed in her. |
484340c8-302a-4c8f-8aba-873527fb57e4 | The year under review represents, as it were, the last year under the old order of things. Henceforth in all your deliberations you will take into your consideration the opening up of the Becontree Estate and look upon Barking as a township with a potential population of 100,000. In January, 1929, I asked for an extension of staff. At that time you decided to wait before acceding to my request. You did not grant this addition to my staff during the year in question but you have done so during the time this report has been in course of preparation. I want to make it quite clear that in assessing the future requirements of Barking you should build as though you had appointed this additional medical staff early in 1929. Towards the end of 1929 the question of nursery schools has been authoritatively raised by the Minister of Health and the President of the Board of Education. It is significant that squalid home conditions are again the only substantial plea for these schools. |
3c344a2d-d5dd-4be4-9de4-3bba22c87358 | I feel that any palliative measures are open to grave objection. Bad environment should be dealt with radically. Money spent on palliative measures merely 5 tends to hide the real trouble, and after all, nothing can take the place of a home for young children, and those homes should be sufficiently good to make palliative measures unnecessary. We have continued to attempt and to achieve closer coordination between the various allied medical activities which are undertaken under your supervision. At the end of July Mr. Smyth relinquished his appointment as dentist in the public medical services to take up private practice in South Africa. Mr. Smyth, throughout the whole of his period of office has maintained a very high standard of professional work, which is appreciated now and which will be appreciated even more in the years that are to come. His place has been most happily tilled by Mr. Foy, who comes to us from Cambridge, and I look forward with confidence to the continued success of this department. I am, Mr. |
88107ba7-3141-47d8-9f78-9c6c307d116a | Chairman, Ladies and Gentlemen, Your obedient servant, C. LEONARD WILLIAMS, School Medical Officer. 6 ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER For the Year 1929. (i) STAFF. The staff of the public medical services is still responsible to two separate committees of the Council. The central government, in conformity with past precedent, will probably await a definite lead from Local Authorities on this important question. I would like Barking to give the necessary lead to the Government by unifying the divided committee work on matters affecting the health of the people. Dr. M. J. Lough died in May, 1929, and Dr. G. Bevan was appointed to fill the vacant post. Mr. H. Smyth left us in July, 1929, and Mr. \Y. H. Foy was appointed to fill his post. The resignation of Miss F. Young was mentioned in the Annual Report for 1928. |
b2bd4cf8-df81-43c1-a98d-5218cc9590d1 | This took effect in January, 1929, and Miss G. Geden was appointed as dental nurse in her place. (2) CO-ORDINATION. Elsewhere I have been happy to pay tribute to the very real team spirit which I have found in Barking, in which all the various departments of your municipal activities play a part. It is this team spirit which makes possible any scheme of government, which on paper might appear rather disjointed. 7 The fact that Medical Officers in Barking carry out work for both the Health Committee and the Education Committee leads to internal co-ordination, and the team spirit of which I have spoken co-ordinates the work of my department with that of other departments. Without my omission of others suggesting anything invidious, I would like to pay tribute to the unification brought about by the appointment Mr. Goodaker fills as Chief Investigation Officer. Mr. |
7d105dd7-104e-4ef7-afd1-e5263866a0bf | Goodaker carries out the duties not only of a School Attendance Officer but also investigates cases for the Public Health Committee, and so has become the repository of an amazing amount of information, which is most helpful to us in our divers capacities. Elsewhere I have called attention to the need there is for unification and although I certainly think we stand in need of unification all the way round, I feel it only right to quote from Sir George Newman's Report on the Health of the School Child for the year 1928, in which he deals with the effective co-ordination between the Ministry of Health and the Board of Education. " The passing of the Ministry of Health Act in 1919 further strengthened the public health association with the school medical service (Section 3 (i) (d).). |
1c6b6fbc-73ea-4c92-ad3c-94360373f8e4 | In accordance with this section a Circular was issued by the Board of Education (Circular 1136, November, 1919), explaining that the Ministry of Health would exercise the provisions of the section and determine the scope and standards of medical inspection and treatment of school children, and the Board 01 Education would be responsible for approving Schemes, paying grants and carrying on the service. In my Report to the Board of Education for 1918 this question was fully discussed (pages 35-39) and the lines of local co-operation suggested. Effective co-ordination between the Ministry of Health and the Board of Education has been in operation since the Act was passed." (3) SCHOOL HYGIENE. For the third time in succession it is my duty to call vour attention to the need there is for the provision at school of facilities for the drying of clothes and boots. 8 This matter was, previous to my appointment, brought to your notice in the report for the year 1926, and is a matter about which I feel quite strongly. |
b14478bf-2dbf-4374-9a2b-b8de288032d8 | I am still prepared to recognise the difficulties which confront you, but do believe that year should not follow year without this matter being dealt with in a radical way. Provision of Meals.—The same arrangements for the provision of meals obtain for 1929 as obtained in previous years, and, having regard to the fact that we can no longer look upon the provision of meals as a purely temporary measure, I think the time has come when the temporary building in which the children are given these meals should be'replaced by a better and a bigger building. I wish to pay the highest tribute to those who are in charge of the children. I think a very high level is indeed reached not only in the meal as such, but also in the way in which the children are given an opportunity of taking the meal under advantageous circumstances; but the building available is so small and the general amenities so inadequate that those who are responsible for looking after the children do not get any real chance of obtaining results commensurate with their efforts. |
6e51ed9f-8b02-45c4-99ad-b4ab678b96bb | The problem of catering for children who stay behind at their ordinary elementary schools for their mid-day meal is not a very real one, as the following table shows. It must, however, be remembered that where the children who remain behind are few in number, there is oftentimes the more need for supervision, and although it might appear at first sight that the public gain from the supervision is hardly commensurate with the effort, it cannot be too often emphasised that correct table manners are far more necessary in after life than many things which find a prominent part in our scholastic curriculum. 9 There is, perhaps, nothing which limits a man's activity and tends to develop an inferiority complex than a feeling of awkwardness when in company at mealtimes, and in addition slovenly habits at the dinner table lay the foundations of dental trouble and of stomach diseases. School. No. of children who do not return home for mid-day meal. Whether facilities exist for heating of children's meals. |
09d4e571-b0c1-4b4d-90c8-896d2447c9a5 | Whether facilities exist for the drying of children's clothes and boots. Park Modern— 25—40 Yes Yes C. of E. Boys — No School fires in winter only. Girls - „ „ Infants — „ „ Ripple— Boys - „ „ Girls — „ „ Infants — „ „ SS. Mary & Ethelburga Mixed 10 Yes „ St. Joseph's Infants 25 „ „ Gascoigne Boys - No „ Girls - „ „ Infants - „ „ Westbury Boys - „ „ Girls - „ Yes—at Laundry Infants - „ School fires in winter only. North Street— Boys 3 „ „ Girls — „ „ Infants - „ „ Castle— 25 • Small stove in teachers private room. School fires in winter only. Faircross— All children stay at school for mid-day meal, the food being supplied from Municipal Kitchen Yes Yes (4) MEDICAL INSPECTION. Routine and special examinations, to be of any worth, must be done well. |
4af60dcc-0594-4ecd-bf3f-39c6b2885789 | On no account should more than twelve children be seen in any hour at routine school medical inspection unless there is some definite explanation or excuse. The average number of inspections per hour should be in the neighbourhood of nine or ten. 10 In Barking we visit most schools three times a year for the purposes of school medical inspection. It is found generally that this does not take up much more time than visiting at less frequent intervals and leads to increased efficiency, the visiting medical officer having an earlier opportunity of following up cases which are required to be kept under observation. I wish to stress the need there is for medical officers to visit schools on their own initiative and at the request of the Head Teachers, apart from these routine visits, and I hope that time will be afforded for this to take place. |
c5c8a888-78f4-40eb-aba6-90969f4fbc38 | May I once more take upon myself what has begun to be a perennial task of explaining that routine inspections are essentially a census of the health of the school population, and that people who object to having their children examined at school because they know them to be healthy or because they are already receiving attention for such disabilities as they may suffer from, make it impossible for you to assess the standard physique of the children who are attending your schools and so make it impossible for you to determine the physical benefits which are conferred on the children under your charge by the form of education you provide. I do hope that everybody interested in the welfare of children will teach in season and out of season that education can only be carried on with physical welfare to the children if you as a Committee have this data, which can only be provided by the examination of all children, ailing or well, under treatment or not under treatment, at routine medical inspections at school. |
1ef17a4f-8447-460b-839b-f0e953285055 | The table herewith included, which is a modification of Table II—B to be found in the appendix to this Report, shows the number of children who have been examined and the number of defective children referred either for treatment or for observation during the years 1928 and 1929. 11 Entrants Intermediates Leavers Specials Other Routine Examinations Total 1928 1929 1928 1929 1928 1929 1928 1929 1928 1929 192S 1929 So. of children examined 946 914 687 958 581 572 141 162 126 339 2491 2945 No. referred for treatment 143 129 115 156 71 76 70 51 22 14 421 426 No. |
b246bc01-a149-4eb5-9a4c-ac8e61521edc | referred for observation 184 251 113 198 54 104 53 67 10 1 414 621 Percentage of defective children 34.6 41.6 33.2 37.0 21.2 31.5 87.3 72.8 26.9 4.4 33.5 35.6 Last year I pointed out that the figures showed an increase on previous years, and again this year I have to report that the amount of work done is again an increase on last year. I do not look upon the increase in the percentage of defective children as really significant. It will be noted that the only significant increase is amongst the children who have been referred for observation and not amongst the children who have been referred for actual treatment. The following table shows the percentage of the children examined who were accompanied by their parents or guardians. Year. Percentage of Children Examined who were Accompanied by Parents. Year. |
6aed0940-d100-4a7d-8aab-4b0c32031744 | Percentage of Children Examined who were Accompanied by Parents. 1925 65.5 1928 64.8 1926* 60.7 1929 65.7 1927 62.7 The number of children on the school register on 31st December, 1929, was 7,284, compared with 7,201 on 31st December, 1928. 12 During the year, the Medical Officer paid 149 visits to 20 departments for inspection purposes, examinations being conducted throughout the year on the various school premises. Certain cases of defect were, as in previous years, referred to the School Clinic for further examination and treatment. The following table shows the number of children examined at routine and special inspections during 1929, classified according to the schools attended, the number of inspections held in each school and the number of parents or guardians present:— School. No. of inspections. Numbers inspected. No. of parents present. Boys. Girls. |
af734451-7cb4-445a-aef2-1d4f85b975c9 | Park Modern 6 49 55 35 Gascoigne 30 310 297 408 North St. 19 213 196 276 Castle 2 22 21 29 Westbury 22 198 217 299 Ripple 28 250 300 423 Faircross 18 178 161 226 St. Joseph's SS. Mary's and Ethelburga's 11 91 99 101 Church of England 13 150 129 138 (5) FINDINGS OF MEDICAL INSPECTIONS. Table II on page 46, gives in detail a return of defects found during the course of routine inspection. The figures in brackets are the comparable figures for last year. (a) Malnutrition.—Malnutrition is not a serious problem in Barking. The provisions you make are adequate and run very smoothly, and 1 have yet to learn that there is any need for any child to attend school feeling really hungry. |
cd37e862-0795-4568-827c-b23f388fcce1 | The number of children who require treatment for malnutrition remains practically constant with last year and is negligible. The number of children who have been kept under observation is somewhat increased. This, however, does not of necessity imply that the situation generally is any different from last year. 13 (b) Uncleanliness.—With reference to uncleanliness the really significant figures are to be found not in Table II on page 46, but in Table V on page 54. More children were examined than last year and more children actually and relatively were found to require treatment. There is a tendency throughout the country to place the cleansing of verminous children where in ordinary cases it should rest, i.e., on the parents—and, as Sir George Newman says in his report for 1928, there is much to be said for this attitude. |
30501627-0e59-401a-ad76-7cfd77171fa0 | My own opinion is that unless the circumstances are exceptional, actual cleansing of children by a public authority should only be done in default, and that whenever carried out a prosecution should follow—the parents being prosecuted for the child having been off school. It is to be remembered that the High Court has decided that absence from school by reason of exclusion for being verminous is not sufficient excuse and is punishable. I wish once more to say that there is no hardship whatever in proceeding with every coercive measure you have to enforce absolute cleanliness so far as infestation is concerned amongst boys. I do not see why every boy with an infested head should not be excluded forthwith and the parents proceeded against. Tiiis year, as last, I want to make it perfectly clear that the greater part of the figures submitted to you of dirty people are children who are constantly dealt with and that, generally speaking, the standard of cleanliness in Barking, is commendable. |
bc031062-3c9d-4c09-b79a-57013653bf57 | 14 It is for this reason that the parents of children habitually infested are a greater nuisance, and I do feel that the mothers of Barking who are striving to keep their children scrupulously clean should have every support the Committee can afford them and that this support can only be given by proceedings being taken where friendly advice and reasonable co-operation have failed. School. Dept. No. of Examinations Nits only. Nits and Vermin (head) Gascoigne Infants 1168 118 4 Boys 1488 33 — Girls 1251 176 1 North St. |
1b90d382-c0fd-4fff-9b77-fee9b5f2f1b4 | Infants 943 65 1 Boys 1032 31 1 Girls 1021 88 3 Castle Infants 238 27 - Boys Girls Westbury Infants 1147 61 3 Boys 1075 18 - Girls 1177 162 3 Ripple Infants 655 45 1 Boys 719 18 — Girls 699 64 4 C. of E. Infants 562 83 3 Boys 624 27 — Girls 573 162 3 St. Joseph's Infants 635 94 6 SS. Mary s & Ethelburga's Boys 362 40 4 Girls Faircross — 509 36 — Park Modern Mixed 710 9 — Defective Footgear.—Cases of children with defective footgear were, as heretofore, referred to the Boots Minor Sub-Committee, who considered applications for the provision of boots in 193 cases, compared with 159 in 1928. |
36859c7c-d524-4f33-946a-81839ca6bcac | In all, 214 children were supplied with boots during the year. (c) Heights and Weights.—The following table gives the average heights and weights of children examined at the three undermentioned age periods in all of the schools, compared with the results at similar age periods in 1925, 1926, 1927 and 1928. 15 Year. Average Height in Inches. Average Weight in Pounds. 5 yrs. 8 yrs. 12 yrs. 5yrs. 8 yrs. 12 yrs. |
ba9c6674-9221-4c77-b95f-7149585d2e85 | 1925 42.1 49.05 56.5 41.1 54-1 78.8 1926 42.4 49.9 57.5 40.3 54.6 82.4 1927 42.2 49.3 57.1 40.6 52.5 80.1 1928 42.1 49.5 57.2 40.2 56.4 81.2 1929 41.9 50.5 56.3 40.9 56.3 83.5 Average for 5 years 42.14 49.65 56.9 40.6 54.78 81.2 (d) Minor Ailments.—The incidence of minor ailments remains approximately the same as for last year. (e) Skin Disease.—The number of cases of skin disease found at routine inspection was quite small. |
dadccd42-bd2a-4e84-9058-9c209ae46d6b | This is a testimony to the efficiency of the service you carry on at the Minor Ailment Clinic. I am sure that most of these cases are dealt with as they arise, with the result that but few of them are found at any school inspection. (/) Eye Disease.—The findings of school medical inspection show no significant deviation from last year and are generally satisfactory. As for diseases of the skin, this circumstance is a tribute to 'he work which is being carried on at the Minor Ailment Clinic. (g) Vision and Squint.—Defective vision, however, showed a slight increase on last year, but on the other hand the number of cases of squint was less than for last year. It is interesting to remark that now, under the Council's Maternity and Child Welfare Scheme, there is an Eyesight Clinic for toddlers—i.e., for children under five. 16 (//) Ear Disease.—The condition of your children with regard to ear disease remains practically as it was last year. |
e0c2e8e1-2a98-4780-a65d-59e41a098789 | (i) Tonsils and Adenoids.—The number of cases of tonsils and adenoids shows a perfectly unwarrantable incidence. There is evidently something basicly wrong with the upbringing of the children. Last year I tentatively suggested a possibility of it being due to an error of diet and I find myself being driven to the conclusion that this opinion is right. Exactly where the deficiency lies I would not like to say, although I shrewdly suspect that the deficiency is really related to bread. A part of the actual increase in the number of cases found requiring treatment may be due to a rather higher standard being set than previously, but I want to make it perfectly clear that no operations are undertaken except on the advice of the surgeon specialist at the hospital where the children are treated. (j) Ttiberculosis.—There were II cases of tuberculosis amongst children of school age notified to the Medical Officer of Health during the year. Of these one was pulmonary and ten Were non-pulmonary. |
5575a81f-0052-4efe-a0fb-d4716757ab2b | The following table shows the position with regard to notification of tuberculosis amongst children of school age during 1929:— Notified during 1929 Pulmonary 1 Non-Pulmonary 10 Total 11 De-notified (of the above) Pulmonary — Non-pulmonary 1 Total 1 17 As reported elsewhere, the revision of the Tuberculosis Register has now been going on for some time, and during the year under review the following numbers of school children have been removed from the Notification Register. Removed from Register. Pulmonary. Non-Pulmonary. Cured 4 12 Amended Diagnosis 25 12 Left District 7 5 Died — *3 Total 36 32 * These 3 deaths did not all occur during the year under review, although all the names have been removed during 1929. Tuberculosis of the lungs amongst children is a relatively rare disease. |
ef26462c-1f9e-461d-8f3b-db4c643cddc1 | It is, however, sufficiently common in Essex for there to be need for the County to make special provision to deal with it. This they have to a certain extent done, and I regret to say that pulmonary tuberculosis amongst school children is definitely existing in Barking. (k) Dental Defects.—Routine medical inspection bears testimony to the efficiency of your dental service. There is yet work to be done by co-ordinated effort in making a higher standard for the first teeth, but generally speaking the permanent teeth are relatively well cared for, and the children leaving your schools show a very good percentage of sound, useful dentures. (I) Crippling Defects.—With reference to crippling defects, we have a very happy state of affairs to record. The findings of routine inspection show a considerable decrease in the number of cases found last year. 18 These figures will vary, up and down, from year to year, and even though they increase, I can assure you there is a progressive movement in the right 'direction. |
5e43ef6f-1f91-47f7-bf19-a9ef347c955c | This movement will not be shown actually by figures because as year succeeds year we hope to be able to maintain a much higher standard. The Orthopaedic Clinic on the Maternity and Child Welfareside is now working so well that gross cases of crippling defects amongst your school children are now quite incidental. There is no way in which your Council has spent more wisely than in looking after the very young children whose deformities would mean serious disablement not only throughout the whole of school life but throughout the whole of life itself. I must, however, point out that there are quite minor physical disabilities which provoke a loss of efficiency apparently out of proportion to the disability, e.g., minor deformities of the spine due to the children adopting negligent attitudes when seated at desks and when standing. These not only throw an undue strain on the whole of the body skeleton, but actually alter the normal relationship of the heart and other organs, with great detriment to the well-being and intelligence of the children. |
4c763ad4-915d-47a2-b247-7c1382640d59 | It is in this connection I would stress the importance of the closest co-operation between the teachers and the school medical inspectors. It is only when teachers have an opportunity of having these minor disabilities pointed out to them while the children are being actually examined that their importance can be rightly appreciated. (6) INFECTIOUS DISEASE. The spread of infectious disease is a matter primarily associated with the home life of the children. Last year I pointed out the very considerable difficulties which present themselves to your teaching staff in helping to prevent the spread of infection and I expressed my appreciation of the very real help we had received from them notwithstanding these difficulties. 19 I would wish this year to discuss the matter from another standpoint, and that is that the education of the mothers and fathers of to-morrow should definitely include positive teaching on the principles underlying the spread of infectious disease. It is in this way only that we can look forward with confidence to the future. |
cf493794-cd2b-458c-b6b6-f770e4445941 | It is obvious on all hands that we have to-day as high, indeed a higher, conception of the responsibilities of parents than we have had for a very long time in this country, but nevertheless we are face to face with the fact that parents are still negligent when it comes to their attitude towards the spread of infection. To a certain extent this is because the home circumstances do not lend themselves to the necessary isolation, and indeed it may be said that in some cases adequate isolation is impossible, but I do feel that if we had a more informed public opinion on the questions involved, even our inadequate amenities could be used to better effect than they are at present. Where the attendance of a school falls below 60 per cent. and in the opinion of the Medical Officer this bad attendance is directly due to the prevalence of infectious disease, the school sessions so affected are not counted in estimating the average attendance for the purpose of grant. During 1929 one certificate was granted for this purpose. |
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